Welcome 2019 Coding Changes!

After a quiet year, expect three significant changes to the way you do your medical coding, as indicated by recent announcements by the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS). Medical coders will see the changes in 2019, making medical coding certification more important than ever.

Based on value-based healthcare, the agencies say they’re working toward, as CMS Secretary Verma Seema told a recent HIMSS convention, “Patients Over Paperwork”.  Patients are demanding more accountability from healthcare providers and payers, and they want to see what they’re getting for the high insurance and co-pay amounts paid, she said.

Physicians continue to be restive, frustrated by complicated rules and electronic health record (EHR)-keeping. Seema called EHRs inefficient and bemoaned how insular the various systems are, still making it difficult for patients’ medical histories to be portable while secure.

In other words, the complaints about quality over cost, record-keeping, and physician autonomy remain. Here are three solutions that will help solve this but affect your work beginning next year:

To continue reading this article please click on the following:  https://www.aapc.com/blog/41446-three-medical-coding-changes/

 

 

CDI and Quality Initiatives

“Documentation that does not support the diagnosis and procedure codes submitted can lead to a reduction, denial, or take back of payments as well as inaccurate quality scores. No matter what the setting is, the goal of clinical documentation improvement (CDI) is to assist in ensuring quality documentation. The documentation must be reliable, precise, complete, consistent, clear, legible, and timely.”

“Can CDI have an impact on quality initiatives? Certainly! The core of many quality initiatives is the health record and the documentation contained within. This article will present a high-level view of some of those quality initiatives and how CDI can help with the attainment of accurate, quality documentation to support the quality initiatives.”

Click on the following link to read the entire article:

http://journal.ahima.org/2018/02/27/cdi-and-quality-initiatives/

 

 

 

MDM: The Driving Force in E/M Assignments

“The medical decision-making (MDM) component of evaluation and management (E/M) services is perhaps the most crucial element in determining the correct level of service assignment for patient encounters. The majority of individuals involved in the E/M coding process may not agree on the interpretation of the components, but would agree that the clinical thought process expressed in the MDM components best describes the level of medical necessity, as well as the level of service necessary for that specific problem.” please click the following link to continue reading the article:  https://www.aapc.com/blog/39748-mdm-the-driving-force-in-em-assignments/

 

 

 

Engaging Providers Key to Value-Based Reimbursement Adoption

“Nearly three-quarters (73 percent) of providers prefer a fee-for-service model over value-based reimbursement structures even though almost one-half acknowledged that the traditional payment model contributed to higher healthcare costs, a recent Bain & Company survey showed.”  please click on the following link to continue reading the article

http://revcycleintelligence.com/news/engaging-providers-key-to-value-based-reimbursement-adoption

 

The How to of Improving Medical Documentation and Coding Practices

“Failing to thoroughly document signs and symptoms, assessments, and treatments of chronic diseases creates a ripple effect of misfortune. First, all relevant codes are not captured; this leads to improper payment (not to mention, an injustice to the patient). The next thing you know, the claim fails a Risk Adjustment Data Validation (RADV) or Office of Inspector General (OIG) audit based on insufficient documentation. The final blow is a funding take-back. Physicians know this, but many of them do not know how to document sufficiently to support the eight to 10 (or more) diagnoses they might list in the assessment. This is where the healthcare business professional’s expertise comes into play.”

Please click on the following link to continue reading.

Query Physicians to Improve Documentation and Dx Coding

 

Focus on Patient, not on Payment

While it is understood that coding and the accuracy of coding does have a financial impact in all organizations, the primary purpose of coding accurately and completely should not be done for dollars. Coding is the language that translates the severity and acuity of the patient and all conditions of the patient and links them to the services being rendered for each unique patient. Coding not only paints the picture of the complexity of the patient, but supports the quality medical care and services provided……
To continue reading please click on the following link

Coding: Focus on Patient, Not on Payment

The Importance of Coding Quality Measurement Standardization

As healthcare moves into an era of highly scrutinized data that is reflective of the quality of care provided, it is in the best interest of healthcare professionals to adopt standardized coding processes and best practices for quality measurement. The article below provides a framework example for reporting root causes of coding variations, survey results on underlying causes, and methods for reporting coding accuracy.  Promoted within are the goals of consistent, reliable data and background information on implementing standardized coding quality measurement to obtain these goals.

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_036926.hcsp?dDocName=bok1_036926

The Importance of Genomics Data Being Represented on EHR Platforms

The article below explains the importance of utilizing genomic data to help forecast the future of personalized healthcare. One in four people go undiagnosed with medical conditions that could be identified through whole genome sequencing.  By using genomically integrated EHRs, physicians and genetic counselors will be able to interpret and identify relevant information using the EHR to better understand a patient’s response to treatment based on their genetic information.

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_051050.hcsp?dDocName=bok1_051050

Patient Engagement Roles Emerging in Healthcare

While many patients want to be involved in their healthcare treatment and payment plans, understanding and accessing personal medical information through emerging technology can be difficult. The article below addresses several issues that patients and medical personnel experience, such as the education of patient portal use. The article also touches on the purpose and benefits of HIM personnel and their roles for providing patient access and training.

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050999.hcsp?dDocName=bok1_050999